Employing Google Trends to Assess Concussion Search Popularity, Seasonality, and Association With High School Sports Participation

ObjectiveThis investigation employs 2004–2020 Google Trends data to correlate concussion search popularity and high school sports participation while assessing search seasonality and factors associated with search escalation.BackgroundEvents linked to concussions, from news to entertainment, altered public perception of concussions and discouraged high-risk activities. Such sentiment likely promoted high school football's 2004–2018 8% decrease in participation, despite simultaneous 8% increase for sports overall. Google Trends (GT) analysis calculates distinct subjects' popularity scores (0–100) by normalizing Google search frequency with other subjects in the same topic. With 35% of patients researching their conditions using Google, tracking concussion popularity scores allows robust analysis of event-driven fluctuation, seasonal variation, and sports impact.Design/MethodsWorldwide GT analysis was conducted for the disease topic “Concussion” with the categorical filter “Health” from 2004 to 2020. This period's monthly popularity scores with annual averages and annual high school sports participation data were subsequently obtained from Google Trends and the National Federation of State High School Associations, respectively.ResultsConcurrence of significant score changes with CTE studies' publication, release of 2015 film Concussion, and the COVID-19 pandemic validates GT's measurement of public interest. From 2006 to 2016, Pearson's correlation coefficients demonstrated strong negative correlation between GT popularity scores for “Concussion” with total number of high school football participants overall (R2 = 0.8553) and participants per school (R2 = 0.9533). Confirming football-related seasonality, one-way ANOVA regression analysis concluded 2004–2020's mean change in month-specific popularity score is not the same (p = 3.193E-08), and months during football season had statistically significant variability (September: p = 4.389E-05) with elevated average z-scores.ConclusionsCoupled with ANOVA regression and normalized analyses, strong negative correlations between concussion popularity score and high school football participation produce quantitative measures of a long-suspected relationship. Tracking concussion popularity and seasonality with Google Trends provides insight into how, when, and why patients are educating themselves online.

Diagnosis and Management of Mild TBI via Eye Tracking

ObjectiveThe purpose of this study is to expose the prevalence of mild traumatic brain injuries among high school football players and to explore the possibility of implementing eye tracking performance as an objective way to assess cases of potential concussion.BackgroundConcussions are one of the most common forms of traumatic brain injury (TBI). Unfortunately, current research suggests that mild TBIs cannot always be accurately diagnosed via routine neurologic examination. Also, most evaluations, such as ImPACT, are survey-style assessments that are time intensive and subjective. Lack of an objective method to rapidly assess concussions on the field raises concern for second-impact syndrome (SIS), which can lead to permanent brain damage or even fatality.Design/MethodsThis multi-part study included a population of 849 high school athletes in from Lubbock, TX. Student athletes filled out a baseline concussion survey, then assessed their eye tracking performance with the EyeGuide Focus, a 10-second test that involves visually tracking a continuous, figure-8 shape. A vector-based system was used to measure the eye-tracking deviation.ResultsForty-two athletes were recorded with a baseline eye-tracking score, and a subsequent eye-tracking score that was labelled as a suspected concussion by a physician. Of those 42, 17 had a follow-up eye-tracking test 2 weeks later. Test scores labelled with suspected concussion had a significantly higher mean raw score than the baseline score. Higher scores indicate greater vector deviation from accurately tracing the figure-8 with the eyes.ConclusionsThe survey results show underdiagnosing of concussions at lower levels of youth sports, which may indicate a lack of resources. As the data shows marked changes between the concussed, baseline, and follow-up scores, eye-tracking promises to be a quick and efficient tool to assess sports-related concussions.

Suicide in Older Adult Men Is Not Related to a Personal History of Participation in Football

Introduction: It is reasonable to estimate that tens of millions of men in the United States played high school football. There is societal concern that participation in football confers risk for later-in-life mental health problems. The purpose of this study is to examine whether there is an association between a personal history of playing high school football and death by suicide.Methods: The subjects were obtained from the Lieber Institute for Brain Development (LIBD) brain donation program in collaboration with the Office of the Medical Examiner at Western Michigan University Homer Stryker MD School of Medicine. Donor history was documented via medical records, mental health records, and telephone interviews with the next-of-kin.Results: The sample included 198 men aged 50 or older (median = 65.0 years, interquartile range = 57–75). There were 34.8% who participated in contact sports during high school (including football), and 29.8% participated in high school football. Approximately one-third of the sample had suicide as their manner of death (34.8%). There was no statistically significant difference in the proportions of suicide as a manner of death among those men with a personal history of playing football compared to men who did not play football or who did not play sports (p = 0.070, Odds Ratio, OR = 0.537). Those who played football were significantly less likely to have a lifetime history of a suicide attempt (p = 0.012, OR = 0.352). Men with mood disorders (p < 0.001, OR = 10.712), substance use disorders (p < 0.020, OR = 2.075), and those with a history of suicide ideation (p < 0.001, OR = 8.038) or attempts (p < 0.001, OR = 40.634) were more likely to have suicide as a manner of death. Moreover, those men with a family history of suicide were more likely to have prior suicide attempts (p = 0.031, OR = 2.153) and to have completed suicide (p = 0.001, OR = 2.927).Discussion: Suicide was related to well-established risk factors such as a personal history of a mood disorder, substance abuse disorder, prior suicide ideation, suicide attempts, and a family history of suicide attempts. This study adds to a steadily growing body of evidence suggesting that playing high school football is not associated with increased risk for suicidality or suicide during adulthood.

Surface-Related High School Football Game Injuries on Pad and No Pad Fields (101)

Objectives: Today’s new generations of artificial turf infill systems are increasingly being installed with lighter weight infill systems, which often incorporate interlocking polypropylene or thermoelastomer pad systems under the fiber-infill layers, reportedly to reduce surface shock, decrease concussions, and enhance shoe: surface stability. At this time, however, the effects of pad systems on high school football trauma during game conditions are unknown. With more than one million athletes playing competitive football, the rise in medical costs, and the increasing popularity of base pads being installed today as an alternative to heavier infill weight systems, this study focused on quantifying the potential influence of this practice on the incidence, mechanisms, and severity of game-related, high school varsity football injuries. Methods: Artificial turf playing fields were divided into two groups based on a pad underlayer or a no pad system. Fifty-eight high schools participated across three states over 7 seasons. Outcomes of interest included injury severity, injury category, primary type of injury, injury mechanism, anatomical location of trauma, type of tissue injured, and elective imaging/surgical procedures. Data were subject to multivariate analyses of variance (MANOVA) and Wilks’ λ criteria using general linear model procedures. Data were expressed as injury incidence rates (IIR) per 10 game season. Results: Of 658 varsity games documented, 260 games were played on fields containing pads, and 398 on no-pad fields, with 795 total injuries reported. MANOVA indicated a significant main effect across pad and no pad playing surfaces by injury severity (F3,791 = 11.436; P < .0001), knee trauma (F9,785 = 2.435; P = .045), injury category (F3,791 = 3.073; P < .0001), primary type of injury (F10,785 = 2.660; P < .0001), injury mechanism (F13,781 = 2.053; P < .001), anatomical location of trauma (F16,778 = 1.592; P < .001), type of tissue injured (F4,790 = 4.485; P < .0001), and elective imaging and surgical procedures (F4,790 = 4.248; P < .002). Post hoc analyses indicated significantly higher ( P < .05) substantial injury [10.3, (95% CI, 10.0-10.5) vs 3.0 (2.5-3.4)], player-to turf trauma [6.5, (95% CI, 5.9-7.1) vs 2.0 (1.6-2.4)], patellofemoral syndrome [1.3, (95% CI, 0.9-1.7) vs 0.3 (0.2-0.5)], neck strain [2.0, (95% CI, 1.5-2.5) vs 0.3 (0.2-0.5)], lower leg strain [3.9, (95% CI, 3.3-4.5) vs 1.1 (0.8-1.4)], and a higher number of lower extremity elective imaging and surgical procedures requested [7.2, (95% CI, 6.7-7.7) vs 3.2 (2.8-3.7)] when competing on artificial turf fields with pads as compared to no pad systems, respectively. In regard to reducing the frequency of concussions, there was no significant difference in concussion rate attributed to turf impact [0.3, (95% CI, 0.2-0.6) vs 0.1 (0.1-0.3)] between pad and no pad fields, respectively. Conclusions: The addition of a pad under an artificial turf surface increases injury rates when compared to non-pad fields across most injury categories. At this time, findings do not support the current trend of installing lightweight padded infill systems at the high school level of play. This is the first longitudinal study to investigate the influence of a pad on sport trauma, when integrated with an artificial turf infill system.